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					Franklin Township
A Proud Somerset County Community

Community/Senior Center
505 DeMott Lane P.O. Box 6704 Somerset, NJ 08873-6704

Phone: 732-873-1991 Fax: 732-873-1595 Dear Parents or Guardi ans, Ordinance #980 provi des for exemption from recreation program fees for i ndi vi duals of low i ncome. Indi vi duals seeking exempti on from fees must complete the form below and show proof of income and or the type of assistance they are recei vi ng. The state approved criteri a for income eligibility followed by the Department of Parks and Recreati on appears in the next section of this letter. If you have any questions please call the Department of Parks and Recreati on at 873-1991. PARENT/ GUARDIAN NAME: ___________________________________________________________ ADDRESS: _________________________________________________________________________ PHONE (home): _____________________________________________________________________ CHILD’S NAME: _________________________________________________ (AGE) _____________ _________________________________________________ _________________________________________________ _________________________________________________ _____________ _____________ _____________ NO ___________ NO ___________

1. I recei ve Ai d to Families with Dependent Children (AFDC) YES _______ 2. The chil d i n my care as a Ward of the State i n Foster care. I recei ve funding from DYFS YES _______ 3. Please indicate the size of your family and your family’s annual income. __________________________ FAMILY HOUS EHOLD SIZE

$_________________ ANNUAL INCOME

Please attach current documentation for AFDC or from DYFS as proof of ai d. A current pay stub and your most recent tax return must also be submitted. Please submit this information to the Franklin Townshi p Department of Parks and Recreation, 505 DeMott Lane, Somerset, NJ 08873. July 1, 2005 to June 30, 2006 FAMILY S IZE/ INCOME MEALS FOR FREE MEALS (as announced by the United States Department of Agricu lture) SCALE IS BAS ED ON GROSS INCOME BEFORE DEDUCTIONS

FREE MEALS HOUS EHOLD S IZE ANNUAL 1 2 3 4 5 6 7 8 Each Additional Family Member 17,705 23,736 29,767 35,798 41,829 47,860 53,891 59,922 +6,031 MONTHLY 1,476 1,978 2,481 2,984 3,486 3,989 4,491 4,994 +503 WEEKLY 341 457 573 689 805 921 1,037 1,153 +116